Opinion statement
The potentially catastrophic presentation and lifelong complications that result from caustic ingestion make it one of the most challenging clinical situations in gastroenterology. Patients who present with a history of caustic ingestion, particularly with a strong alkali or acid, should undergo emergent endoscopy once stabilized to assess the degree of oropharyngeal, esophageal, and gastric damage regardless of presence or lack of symptoms. Once staged, patients with moderate to severe injury should be restricted from any oral intake, placed on intravenous fluids, and observed, provided there are no signs of perforation or transmural necrosis that require immediate esophagectomy. For those who will require lengthy periods without oral intake, feeding should be initiated through a jejunostomy tube (preferably) or through total parenteral nutrition. Patients that have survived the first several weeks of injury should be reassessed for esophageal stricture formation. Chronic strictures may require serial dilations initially to establish patency and in some patients, dilation will be needed chronically to maintain the adequate lumen diameter. More severe strictures may require esophagectomy or bypass with colon or small bowel interposition. Finally, although there is an increased incidence of esophageal carcinoma in these patients, regular endoscopic screening is not advocated.
Similar content being viewed by others
References and Recommended Reading
Bulletin of the National Clearing House for Poison Control Centers, vol. 25, no. 6. Rockville, MD: National Clearing House for Poison Control Centers; 1981:1–75.
Leape L, Ashcraft KW, Scarpelli DG, Holder TM: Hazard to health—liquid lye. N Engl J Med 1971, 284:578–581.
Butler C, Madden JW, Davis WM, Peacock EE: Morphologic aspects of experimental esophageal lye strictures. II. Effect of steroid hormones, bougienage, and induced lathyrism on acute lye burns. Surgery 1977, 81:337–341.
Goldman LP, Weigert JM: Corrosive substance ingestion: a review. Am J Gastroenterol 1984, 79:85–90.
Katzka DA: Caustic injury to the upper gastrointestinal tract. In Clinical Practice of Gastroenterology, vol 1. Edited by Brandt L. Philadelphia: Current Medicine, Inc; 1999:96–104.
Webb WR, Koutras P, Ecker RR, et al.: An evaluation of steroids and antibiotics in caustic burns of the esophagus. Ann Thorac Surg 1970, 9:95–102.
Anderson KD, Rouse TM, Randolph JG: A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990, 323:637–640. The only controlled randomized trial examining the effects of corticosteroids on survival and stricture formation after caustic ingestion.
Gaudrealut P, Parent M, McGuigan MA, et al.: Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics 1983, 71:767–770.
Crain EF, Gershel JC, Mezey AP: Caustic ingestions. Symptoms as predictors of esophageal injury. Am J Dis Child 1984, 139:863–865.
Cello JP, Fogel RP, Boland CR: Liquid caustic ingestion. Spectrum of injury. Arch Intern Med 1980, 140:501–504.
Bautista Casanovas A, Estevez Martinez E, Varela Cives R, et al.: A retrospective analysis of ingestion of caustic substances by children. Ten-year statistics in Galacia. Eur J Pediatr 1997, 156:410–414.
DiCostanzo J, Moirclerc M, Jouglard J, et al.: New therapeutic approach to corrosive burns of the upper gastrointestinal tract. Gut 1980, 21:370–375.
Symbas PN, Vlasis SE, Hatcher CR Jr: Esophagitis secondary to ingestion of caustic material. Ann Thorac Surg 1983, 36:73–77.
Karnak J, Tanyel FC, Buyukpamukcu N, Hicsonmez A: Combined use of steroid, antibiotics and early bougienage against stricture formation following caustic esophageal burns. J Cardiovasc Surg 1999, 40:307–310. An uncontrolled trial, but recent experience with the disease.
Broto J, Asensio M, Jorro CS, et al.: Conservative treatment of caustic esophageal injuries in children: 20 years of experience. Pediatric Surg Int 1999, 323–325. A recent retrospective study with relatively large patient population for this problem.
Brun JG, Celerier M, Koskas F, Dubost C: Blunt esophageal stripping: an emergency procedure for caustic ingestion. Br J Surg 1984, 71:698–700.
Estrera A, Taylor W, Mills LU, Platt MR: Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach. Ann Thorac Surg 1986, 41:276–283. A small number of patients, but points out both the benefits and pitfalls of early surgical intervention.
Lai K-H, Huang B-S, Huang M-H, et al.: Emergency surgical intervention for severe corrosive injuries of the upper digestive tract. Chin Med J 1995, 56:40–46.
Andreoni B, Farina ML, Biffi R, Crosta C: Esophageal perforation and caustic injury: emergency management of caustic ingestion. Dis Esoph 1997, 10:95–100.
Cattan P, Munoz-Bongrand N, Berney T, et al.: Extensive abdominal surgery after caustic ingestion. Ann Surg 2000, 231:519–523.
Zargar SA, Kochhar R, Nagi B, et al.: Ingestion of strong corrosive alkalis: spectrum of injury to the upper gastrointestinal tract and natural history. Am J Gastroenterol 1992, 87:337–341. A nice review.
Broor SL, Bose PP, Lahoti D, et al.: Long term results of endoscopic dilatation for corrosive esophageal strictures. Gut 1993, 34:1498–1501.
Csikos M, Horvath O, Petri A, et al.: Late malignant transformation of chronic corrosive esophageal strictures. Langenbecks Arch Chir 1985, 365:231–238.
Appelqvist P, Salmo M: Lye corrosion carcinoma of the esophagus. Cancer 1980, 45:2655–2658. The largest retrospective series associating squamous cell carcinoma of the esophagus with a prior history of lye ingestion.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Katzka, D.A. Caustic injury to the esophagus. Curr Treat Options Gastro 4, 59–66 (2001). https://doi.org/10.1007/s11938-001-0047-x
Issue Date:
DOI: https://doi.org/10.1007/s11938-001-0047-x